Brookfield, WI · On-site +1
Conduct utilization reviews and obtain prior authorizations from insurance companies * Monitor continued stay and discharge criteria for clients * Communicate effectively with clinical and ...
Quick apply
Brookfield, WI · On-site +1
Conduct utilization reviews and obtain prior authorizations from insurance companies * Monitor continued stay and discharge criteria for clients * Communicate effectively with clinical and ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
Menasha, WI · On-site +1
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
Menasha, WI · On-site +1
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
Description The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews ...
Description The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable ...
Description The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews ...
Description The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews ...
No Department Details Oversee health plan utilization management department operations including prior authorization, and concurrent review focusing on improving care quality and outcomes across a ...
No Department Details Oversee health plan utilization management department operations including prior authorization, and concurrent review focusing on improving care quality and outcomes across a ...
$72K - $98K/yr
... utilization review processes to assure continuity for the most appropriate level of care for ... Perform insurance benefit verifications and secure initial pre-authorization for treatment and ...
New
$72K - $98K/yr
... utilization review processes to assure continuity for the most appropriate level of care for ... Perform insurance benefit verifications and secure initial pre-authorization for treatment and ...
New
$17 - $19/hr
... authorization and utilization review processes, coordinating vendor referrals, and assisting with subpoenas, liens, and claim file management activities. Responsibilities * Organizes the digital ...
$17 - $19/hr
... authorization and utilization review processes, coordinating vendor referrals, and assisting with subpoenas, liens, and claim file management activities. Responsibilities * Organizes the digital ...
South Milwaukee, WI · Remote
$69.41 - $103.25/hr
... utilization review; Applies strategies within daily operations to identify trends and address gaps to facilitate authorizations and reduce preventable denials; Facilitates cross-functional ...
South Milwaukee, WI · Remote
$69.41 - $103.25/hr
... utilization review; Applies strategies within daily operations to identify trends and address gaps to facilitate authorizations and reduce preventable denials; Facilitates cross-functional ...
... utilization review processes to assure continuity for the most appropriate level of care for ... Perform insurance benefit verifications and secure initial pre-authorization for treatment and ...
New
... utilization review processes to assure continuity for the most appropriate level of care for ... Perform insurance benefit verifications and secure initial pre-authorization for treatment and ...
New
Oshkosh, WI · On-site
$80K - $90K/yr
New admission authorizations, updates, communication with family/insurance providers, communication ... Run Utilization Review Meetings and ensure PDPM scores and rates are validated * Review and Educate ...
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Oshkosh, WI · On-site
$80K - $90K/yr
New admission authorizations, updates, communication with family/insurance providers, communication ... Run Utilization Review Meetings and ensure PDPM scores and rates are validated * Review and Educate ...
$26.41 - $51.49/hr
... utilization management (UM) policies and procedures. Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
$26.41 - $51.49/hr
... utilization management (UM) policies and procedures. Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
$26.41 - $51.49/hr
... utilization management (UM) policies and procedures. Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
$26.41 - $51.49/hr
... utilization management (UM) policies and procedures. Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
$26.41 - $51.49/hr
... utilization management (UM) policies and procedures. Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
$26.41 - $51.49/hr
... utilization management (UM) policies and procedures. Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
$26.41 - $51.49/hr
... utilization management (UM) policies and procedures. Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
$26.41 - $51.49/hr
... utilization management (UM) policies and procedures. Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
$26.41 - $51.49/hr
... utilization management (UM) policies and procedures. Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
$26.41 - $51.49/hr
... utilization management (UM) policies and procedures. Required Qualifications • At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization ...
| Aspect | Authorization Utilization Review | Claims Reviewer |
|---|---|---|
| Credentials | Typically requires healthcare or insurance-related certifications, such as RN, CPC, or licensed healthcare professionals | Often requires similar credentials, focusing on insurance policies and claims processing |
| Work Environment | Hospitals, insurance companies, healthcare facilities | Insurance companies, third-party administrators, healthcare organizations |
| Industry Usage | Used to assess medical necessity before approving services | Used to evaluate claims for payment accuracy and compliance |
Authorization Utilization Review and Claims Reviewer roles both involve insurance and healthcare knowledge, but Authorization Utilization Review focuses on pre-authorization of services, while Claims Review centers on post-service claims assessment. Understanding these differences helps clarify career paths and job expectations in healthcare insurance.
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 26 days ago
Utilization Review Specialist – Behavioral Health Facility
We are seeking a confident, detail-oriented Utilization Review Specialist to join our behavioral health team. This role involves reviewing clinical documentation, ensuring medical necessity, managing insurance authorizations, and collaborating with providers to support appropriate and timely care for our clients.
Responsibilities:
Conduct utilization reviews and obtain prior authorizations from insurance companies
Monitor continued stay and discharge criteria for clients
Communicate effectively with clinical and administrative teams
Maintain accurate and up-to-date documentation
Ensure all documentation meets insurance and regulatory compliance standards and is completed accurately and on time.
Qualifications:
Background or experience in social work, counseling, or behavioral health is preferred
Experience in utilization review or case management for behavioral health is preferred
Strong communication and organization skills
Ability to work efficiently in a fast-paced environment
Confident, proactive, and dedicated work ethic
Benefits: Competitive salary Opportunities for professional development and career advancement Supportive and collaborative work environment Fulfilling work helping individuals with mental health or substance abuse issues
Benefits:
401(k)
Dental insurance
Flexible schedule
Health insurance
Life insurance
Paid time off
Vision insurance
